Acute effects of peritoneal dialysis on hemodynamics

Objectives:To investigate the acute hemodynamic effects of peritoneal dialy sis (PD) using the noninvasive Portapres technique [TNO Biomedical Instrume ntation (TNO BMI); Amsterdam, The Netherlands]. Design and Methods: Blood pressure was measured in 21 consecutive patients on continuous ambulatory PD during a standard peritoneal permeability analy sis (SPA). Blood pressure, stroke volume, cardiac output, and total periphe ral resistance were recorded and calculated using continuous finger pressur e recordings with Portapres and Modelflow software (TNO BMI). The SPA consi sts of four phases: (1) drainage of night dwell dialysate, (2) instillation of a rinsing solution (1.36% glucose), (3) drainage of rinsing solution, a nd (4) instillation of the test solution (3.86% glucose to which dextran 70 has been added). Results: Both systolic blood pressure (SBP) (7 +/- 9 mmHg, p< 0.005) and di astolic blood pressure (DBP) (5 +/- 6 mmHg, p < 0.01) increased during phas e 2. Systolic BP and DBP increased further during phase 4 (SBP 8 +/- 14 mmH g, p< 0.05; DBP 6 +/- 8 mmHg, p< 0.005). These BP increases were caused by a rise in total peripheral resistance of 10% +/- 18% (p < 0.05) during phas e 1, and 15% +/- 21% (p < 0.005) during phase 2. Conclusions: Instillation and dwell of a dialysis solution during PD causes a rise in blood pressure. This is caused by an increase in total periphera l resistance. Factors influencing total peripheral resistance could be a di rect mechanical effect of dialysate on mesenteric resistance vessels or a t emperature-related effect.